A large congenital and solitary intrahepatic arterioportal fistula in an old woman

Arterioportal fistula(APF)is a rare cause of portal hypertension and may lead to death.APF can be congenital,post-traumatic,iatrogenic(transhepatic intervention or biopsy)or related to ruptured hepatic artery aneurysms.Congenital APF is a rare condition even in children.In this case report,we describe a 73-year-old woman diagnosed as APF by ultrasonography,computed tomography,and hepatic artery selective arteriography.The fistula was embolized twice but failed,and she still suffered from alimentary tract hemorrhage.Then,selective arteriography of the hepatic artery was performed again and venae coronaria ventriculi and short gastric vein were embolized.During the 2-year follow-up,the patient remained asymptomatic.We therefore argue that embolization of venae coronaria ventriculi and short gastric vein may be an effective treatment modality for intrahepatic APF with severe upper gastrointestinal bleeding.

计算机断层扫描(CT)直方图在甲状腺良性孤立性粗钙化结节诊断中的价值（英文）

目的:探讨CT直方图在甲状腺良性孤立性粗钙化结节(BSCN)诊断中的价值。创新点:首次采用CT直方图来对甲状腺结节进行良恶性的鉴别诊断,并找到有较好临床诊断价值截点值。方法:收集2009年1月至2015年12月期间,经手术及病理证实的甲状腺孤立粗钙化结节(粗钙化直径≥5 mm,周围无软组织)86例89枚,包括54例56枚BSCNs和32例33枚恶性孤立性粗钙化结节(MSCNs)。在200~1500 HU的范围内,以50 HU的N(4≤N≤30)倍为截点,共计27个,记录CT直方图中BSCN和MSCN各截点及其所占面积百分比的差异,通过ROC曲线确定诊断BSCN的最佳截点及其面积百分比。结论:在19组受试者工作特征曲线(ROC)面积超过0.7的数据中,当800 HU和面积百分比≤93.8%时,准确度最高,为75.3%,敏感度和特异度分别为80.4%和66.7%;当1050 HU和百分比≤93.6%时,准确度为71.9%,敏感度和特异度分别为60.7%和90.9%;当1150 HU和百分比≤98.4%时准确度为70.8%,敏感度和特异度分别为57.1%和93.9%;当600 HU和百分比≤12.1%时准确度为61.8%,敏感度和特异度分别为39.3%和100%。与截点800 HU和面积百分比≤93.8%比较发现,尽管1050 HU和百分比≤93.6%、1150 HU和百分比≤98.4%、600 HU和百分比≤12.1%对BSCN诊断的敏感度有所降低,但特异度显著升高,从而为BSCN患者减少了不必要的手术创伤。